Congenital lumbar herniae: a systematic review

Ultrasonography for Rare Lumbar Hernia Diagnosis: Multimodal Imaging Insights

This case report highlights the role of ultrasonography in diagnosing a rare right lumbar hernia in a 57-year-old male presenting with a painless lumbar mass. Ultrasound revealed a hypoechoic mass with disrupted fascial continuity. CT imaging was used for confirmation, showing herniated omental fat. The patient underwent successful surgical repair with mesh implantation and experienced an uneventful recovery. This case underscores the diagnostic value of ultrasonography as a non-invasive, real-time imaging modality in identifying lumbar hernias and differentiating them from other soft tissue masses, complemented by CT for comprehensive evaluation. Early diagnosis ensured effective management and favorable outcomes for the patient.

A rare case of renal eventration in a domestic cat

This case report discusses a unique case of renal eventration in a cat resulting from a lumbar hernia possibly of traumatic origin. A two-year-old indoor/outdoor male neutered domestic shorthair was evaluated for a rapidly growing mass noted in the right lumbar region. Initial physical examination revealed a firm, circular and slightly mobile mass in the lumbar region, along with pain and tenderness on palpation. Abdominal ultrasound revealed muscle discontinuity in the lumbar region consistent with a hernia, with eventration of the right kidney possibly caused by abdominal trauma. A paralumbar celiotomy was performed over the area of increased volume, revealing the right kidney with a hematoma on its surface and partial rupture of the renal capsule. The muscular defect was identified, and the kidney replaced in its anatomical location. The patient recovered quickly and was discharged from hospital 46 h later, with no reported complications. Recheck 2 months post-operatively confirmed unremarkable biochemical assessment (creatinine, urea and USG within normal limits) and abdominal ultrasound findings, and 2 years post procedure the patient remained clinically well. This unusual case emphasizes the importance of including renal eventration in the differential diagnosis for acutely presenting masses in the lumbar region of cats.

A Case Report of Laparoscopic-Assisted Repair of a Rare Congenital Lumbar (Grynfeltt-Lesshaft) Hernia

A congenital lumbar hernia is a rare type of hernia that can affect children born with lumbo-costo-vertebral syndrome. This case report is the first to describe a hybrid laparoscopic-assisted approach, which enabled precise intra-operative localization of a pediatric congenital lumbar hernia, and definitive surgical repair was then undertaken through an open approach. Unlike prior studies that have focused solely on either open or laparoscopic techniques, this hybrid approach offers a new strategy to improve surgical accuracy, particularly where imaging and clinical examination are inconclusive. Our literature review found that open and laparoscopic repair of congenital lumbar hernias are both safe and feasible approaches, with the choice of either depending on the surgeon's preference and expertise.

Traumatic lumbar hernia: A systematic review of the literature

PURPOSE

Traumatic lumbar hernia (TLH) constitutes a protrusion of content through a defect in the posterior abdominal wall, as a result of injury. This rare entity has been described in limited number of cases.

METHODS

A systematic review of the literature was performed according to the meta-analysis of observational studies in epidemiology guidelines. The English literature from 1990 until 2021 was reviewed, using PubMed, EMBASE and Google Scholar bibliographic databases, to identify case reports and case series with patients that were diagnosed with TLH. For each eligible study, demographics, clinical presentation, hernia characteristics, preoperative imaging investigations, operation details, and postoperative data were extracted for assessment. Statistical analysis was performed on SPSS, version 20.0.

RESULTS

A total of 62 studies were included for review, with 164 patients with TLH. Mean age was (42.6 ± 14.3) years (47.6% males, 31.1% females, gender not specified in 35 cases). Mean diameter of hernia neck was (6.3 ± 3.1) cm, while the triangles of Petit and Grynfeltt were affected in 74.5% and 14.6%, respectively. Patients diagnosed in the emergency setting account for 54.2%, with CT scan establishing diagnosis in all but one case (97.7%). A delayed diagnosis was made in 45.8%, at a mean 1 year following trauma. Flank bulging (82.8%) and chronic back pain (34.3%) were the most frequent symptoms. In both delayed and acute group, open surgery (63.6% and 92.3%, respectively) was the preferred surgical approach. Postoperative complications were reported in 11.4% of acute and 15.0% of delayed patients. Hernia recurrence was 7%.

CONCLUSIONS

TLH is uncommon with 164 cases described since 1990. CT scan is the gold standard in diagnosis. Open surgery is generally the preferred approach, particularly in the emergency setting. Acute TLH can be treated either by primary suture repair or mesh, depending on the local conditions, whereas delayed cases usually require a mesh.

Primary Lumbar Hernia, Review and Proposals for a Standardized Treatment

A lumbar abdominal wall hernia is a protrusion of intraperitoneal or extraperitoneal contents through a weakness in the posterior abdominal wall, usually through the superior or inferior lumbar triangle. Due to its rare occurrence, adequate knowledge of anatomy and methods for optimal diagnosis and treatment might be lacking with many surgeons. We believe a clear understanding of anatomy, a narrative review of the literature and a pragmatic proposal for a step-by-step approach for treatment will be helpful for physicians and surgeons confronted with this condition. We describe the anatomy of this condition and discuss the scarce literature on this topic concerning optimal diagnosis and treatment. Thereafter, we propose a step-by-step approach for a surgical technique supported by intraoperative images to treat this condition safely and prevent potential pitfalls. We believe this approach offers a technically easy way to perform effective reinforcement of the lumbar abdominal wall, offering a low recurrence rate and preventing important complications. After meticulously reading this manuscript and carefully following the suggested approach, any surgeon that is reasonably proficient in minimally invasive abdominal wall surgery (though likely not in lumbar hernia surgery), should be able to treat this condition safely and effectively. This manuscript cannot replace adequate training by an expert surgeon. However, we believe this condition occurs so infrequently that there is likely to be a lack of real experts. This manuscript could help guide the surgeon in understanding anatomy and performing better and safer surgery.

Retrospective analysis of 16 cases of lumbar hernia

Background

Through a retrospective analysis of 16 cases of lumbar hernia, we discussed the anatomical basis, clinical manifestations, diagnosis, and treatment of this rare condition.

Methods

We collected medical data of 15 patients with a primary lumbar hernia and one patient with a secondary lumbar hernia treated in the General Surgery Department of Wuxi No.2 People's Hospital between January 2008 and June 2021 and analysed their demographic, preoperative, and postoperative data.

Results

All patients underwent elective surgery performed by the same treatment team for superior lumbar hernias. The median area of the hernia defect was 12 cm2. Fifteen patients underwent sublay repair, and one underwent onlay repair. The median operative time and blood loss were 48 min and 22 mL, respectively. The hernia contents were extraperitoneal fat in 15 patients and partial small intestine in one. The median visual analogue scale score on postoperative day 1 was 3. A postoperative drainage tube was placed in three cases but not used in 13. The median duration of hospital stay was 5 days. Postoperative incision infection occurred in one case. During the follow-up period, no postoperative complications, including haematoma, seroma, incision infection or rupture, recurrence, and chronic pain, occurred in the other 15 cases.

Conclusion

Lumbar hernias are rare and can be safely and effectively treated by open tension-free repair.